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目的比较食管癌切除术手工分层吻合和器械吻合两种吻合方式下的医疗费用以及医疗资源的利用效率。方法回顾性分析甘肃省肿瘤医院胸外科2011年1~10月行食管癌手术132例患者的临床资料,按手术吻合方式不同将患者分为手工分层吻合组[简称手工吻合组,60例,男40例、女20例,年龄36~72(49.3±7.6)岁]和器械吻合组[72例,男50例、女22例,年龄30~79(51.0±8.6)岁]。比较两组患者一般资料、手术资料、术后并发症、直接和间接医疗费用以及直接医疗费用的构成。结果食管癌切除术采用三叶钳辅助食管胃手工吻合组的医疗成本为(14 505.03±1 523.37)元,器械吻合组为(19 891.05±1 634.58)元,差异有统计学意义(P<0.05);手术材料费分别为(2 242.00±751.08)元和(5 424.00±1 876.22)元,差异有统计学意义(P<0.05)。成本-效果分析结果显示手工吻合组成本-效果比值低,该治疗方案较合理。结论与食管癌切除术器械吻合相比,手工分层吻合方式医疗费用更低,因技术优势其卫生资源可利用率高于器械吻合。
Objective To compare the medical costs under the two types of anastomosis of esophageal cancer resection and manual stratified anastomosis and the utilization of medical resources. Methods The clinical data of 132 patients undergoing esophageal cancer operation from January to October 2011 in Department of Thoracic Surgery, Tumor Hospital of Gansu Province were retrospectively analyzed. The patients were divided into manual stratified anastomosis group (referred to as manual anastomosis group, 60 cases, There were 40 males and 20 females, ranging in age from 36 to 72 (49.3 ± 7.6) years old and in the anastomosis group (72 males and 50 males and 22 females, aged 30-79 years (51.0 ± 8.6) years). General information, surgical data, postoperative complications, direct and indirect medical costs, and direct medical costs were compared between the two groups. Results The medical cost of three-leaf forceps assisted esophageal manual anastomosis was (14 505.03 ± 1 523.37) yuan for esophagectomy and (19 891.05 ± 1634.58) yuan for esophageal cancer resection, the difference was statistically significant (P0.05 ); The cost of surgical materials were (2 242.00 ± 751.08) yuan and (5 424.00 ± 1 876.22) yuan, respectively, the difference was statistically significant (P <0.05). The cost-effectiveness analysis showed that the manual cost-to-effect ratio was low and the treatment regimen was reasonable. Conclusions Compared with esophageal cancer resection apparatus, manual stratified anastomosis is more cost-effective for medical treatment, and the utilization rate of medical resources is higher than that of instruments due to technical advantages.